Tamoxifen: Wonder drug?

In 1992, my mother at 60 years of age was diagnosed with an early stage of breast cancer. At the time, she was offered a mastectomy or lumpectomy and follow-up tamoxifen (Nolvadex). She opted for a mastectomy and started on a course of tamoxifen that was supposed to be for 10 years. My mother lasted two weeks on the drug. She experienced diarrhea and mood swings and she finally decided to have no more of it. To date, breast cancer has not recurred. The March 1, 2007 issue of “Cancer”addresses the issue of early termination of tamoxifen by women prescribed this drug in follow up to chemotherapy or as a preventative measure against breast cancer. In fact, the issue reports that nearly 25 percent of women discontinued tamoxifen within the first year of treatment. This is much higher than previously thought in clinical practice. The study goes on to reveal that after 3.5 years of treatment, over one third of women have discontinued these meds. “Science Daily,” a source that reported these findings further states that scientists estimate that over 40,000 recurrences of breast cancer are prevented each year by tamoxifen.

We know by now that five years is the optimum treatment duration with tamoxifen, however, the article goes on to assert that discontinuing the drug before five years is up can be related to a higher incidence of recurrence and mortality. What this means to you is that there is sufficient evidence to suggest that taking tamoxifen for the prescribed five years provides optimal effect against breast cancer in reducing risk of recurrence and decreasing chances of mortality from the disease.

I have put a lot of effort to highlighting the side effects and lack of clinical long term research in the use of aromatase inhibitors like Arimidex (anastrozole). Tamoxifen in my mind is a safer and more reliable medication precisely because it has been used in a clinical setting for over 20 years. There are serious side effects such as uterine cancer and blood clots, however the incidence of these is very small and can be monitored.

It was found that women between 35 and 44 and those over 75, were more likely to quit tamoxifen use and not take an alternative. Furthermore, women who started taking an antidepressant within the first year of tamoxifen use also stopped treatment early. The most common reasons were because of hot flashes and mood swings (ironically, antidepressant medication is effective in dealing with these).

I have highlighted in earlier blogs and restate it now; before discontinuing any medication for any reason you need to discuss it with your doctor. You have the right and responsibility to take charge of your treatment; however you need to know what stopping the drug will do to your risk, and more importantly, how to safely stop the medication.

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ABOUT THE AUTHOR

Kathy-Ellen Kups, RN

Kathy-Ellen is a Registered Nurse living in Michigan. In 2003, Kathy-Ellen was diagnosed with stage three breast cancer. She was cancer-free from April 2004 until December of 2013 when it was discovered that...read more